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Correspondence to Dr Shashank Ravi, Stanford University School of Medicine, Stanford, CA 94304, USA; [email protected]
Introduction
The COVID-19 virus rapidly triggered a global health emergency alert from the WHO, with the first known case in the USA occurring in January 2020 and spreading to 46 countries by 27 February 2020.1 As cases spread within the USA, and globally, hospitals were forced to quickly implement protocols to screen, isolate and treat a surge of potentially COVID-19-infected patients. Changes in protocols required continuous awareness of transforming institutional infection control and local public health department recommendations, recursively communicating a new vision, bolstering morale and anchoring certain workflows as necessary components of ongoing change.2 These aspects presented unique challenges requiring a strategic approach in order to successfully adapt to the rapidly changing COVID-19 landscape.
Approaches to effectively bring about change are often taught in business school, with the most frequently used being John Kotter’s industry-proven framework that outlines the eight-steps of the change process.3 Although seldom used for emergency department (ED) operations, our team recognised during the early implementation of these rapid changes that a change management framework should be guiding decision making. Although previous scholars applied other change management frameworks in healthcare settings, such as TeamSTEPPS and KINDER,4 5 we harnessed Kotter’s 8-stage change model (see figure 1) as our change management framework due to its broad applicability, proven success in other settings, and familiarity among our own operational leaders. Therefore, after evaluating all possible frameworks, we began purposefully using Kotter’s framework to focus decision making during the early stages of the pandemic This report describes the affordances of how using a corporate change model (ie, Kotter) during the pandemic supported us with managing acute healthcare challenges.
Methods
Setting
The ED at Stanford Health Care (SHC) is a tertiary care, level I trauma, academic department, with approximately 80 000 patients seen in 2019. We provide a retrospective report on the changes implemented across the combined staff of 90 attending physicians, 60 resident physicians, and approximately 200 clinical nurses.
SHC is a unique testing environment because on 3 March 2020, we were one of the first independent laboratories in the USA to implement an in-house-developed coronavirus PCR detection test within our clinical practice. As the...